Exploring behavioral factors and emotional mechanisms underlying older adult users' adoption of smart health services: evidence from PLS-SEM and fsQCA.

Introduction: In a population aging society, home-based older adult care as the primary model have experienced a robust growth in demand for smart health services (SHS), reflecting an active response to evolving older adult care needs. However, older adult users' adoption rates are constrained by the interplay of technological and emotional factors, with the underlying mechanisms remain unclear.

Methods: To address this concern, this study integrates the Technology Acceptance Model (TAM) and Emotional Durable Design (EDD) theory to uncover the behavioral factors and emotional driving mechanisms behind older adult users' adoption of SHS. A total of 244 valid questionnaires from older adult users were collected. Partial Least Squares Structural Equation Modeling (PLS-SEM) was employed to analyze the net effects of variables, combined with fuzzy-set Qualitative Comparative Analysis (fsQCA) to identify configurational paths.

Results and discussion: The results show that perceived ease of use, perceived usefulness, and perceived emotion directly and positively influence behavioral intention. Mental interaction, self-actualization, and dynamic adaptation in emotional durable design exert indirect effects on behavioral intention through internalization processes. fsQCA identified 7 configurational paths leading to high behavioral intention, confirming the combined effects of "technology-emotion" factors, with no single factor constituting a necessary condition. This study contributes to expanding the emotional explanatory dimension of TAM, providing a theoretical foundation and practical guidelines for the human-centered design and promotion of SHS.